The American Nurses Association (ANA) recently revised its Code of Ethics, which had not been updated since 2001.1 First, “we established a working group to make recommendations as to whether changes were actually needed, because the code was quite good as it was,” says Martha Turner, PhD, RN-BC, assistant director of the ANA’s Center for Ethics and Human Rights.
More than 3,000 registered nurses submitted comments during a four-year revision process. (To view the complete Code of Ethics, go to http://bit.ly/1FsZxy3.) Changes were made by a steering committee, and again the code was put out for public comment. “We got another 980 responses with about 1,500 suggestions. We made some final changes, and the board of directors approved it,” says Turner. The group used a qualitative research process, which clustered ideas and identified common themes.
Changes to the code’s nine provisions include updated language to address social media, technology, and genetics. “The first three provisions emphasize the fundamental values of the nursing/patient relationship,” says Turner. The next three provisions address boundaries of duty and loyalty when conflicts arise with employers or colleagues. “The final three provisions address duties beyond our individual patient encounters, to the greater world around us,” says Turner.
The code emphasizes that nurses in any role and any setting have leadership responsibilities. “We talk about differences in the terms for what nurses ‘must’ do, ‘should’ do, and ‘ought to’ do, so the provisions could be better understood,” notes Turner.
The revised code gives nurses “a solid foundation to stand on in one’s scope of practice,” says Helen Stanton Chapple, PhD, RN, MA, MSN, CT, a nurse ethicist and associate professor at Creighton University’s Center for Health Policy and Ethics in Omaha, NE. “That scope has been expanded and broadened in this code.”
The code defines a non-negotiable standard of practice for nurses, says Chapple. “As such, it gives nurses an even firmer basis for voicing ethics concerns and broader arenas in which to invest those concerns,” she says.
POSSIBLE CONFLICT WITH POLICIES
Turner says the first step is for nurses and others to read the code. Next, they should integrate it into the hospital’s policies and procedures. “If there is a conflict between the code and what nurses are expected to do, it should be resolved so nurses have no question about what to do,” she adds.
The code gives nurses guidance on ethical interactions with colleagues. “If you use the code well, you can anticipate problems that may come up in the work setting,” says Turner. The code can provide much-needed support for nurses who feel they’re being asked to do something unethical. “When a policy comes down from corporate, you can say, ‘Is this consistent with what the code says?’” says Turner.
For instance, nurses may be uncomfortable discharging a patient home if they know that caregivers are unable to safely care for the patient. In this case, says Turner, nurses can advocate for other arrangements. “That theme of safety is found throughout the code,” she says.
Nurses are often privy to information of which physicians are unaware. “Patients talk to nurses about things that they don’t tell physicians,” says Turner. “It’s often in the middle of the night when patients will discuss their worries or realities in their life.”
The code stresses working as a team. “If we are not being listened to, we need to step forward instead of just saying, ‘Well, it’s not my decision,’” says Turner. “Nurses must pursue these situations until they are resolved.”
If an impaired physician is putting patients at risk, an individual nurse might not be comfortable confronting the issue. “There is strength in numbers,” says Turner. “Nurses collectively on a unit can go forward to management with the code in hand.” The following are some ethical issues addressed in the updated code:
• Informed consent and genetics.
“Genetics is, in some ways, divisive at this point in time,” says Turner. Some believe that once acquired, genetic information should be available for research generally without specific permission from individuals; others think that every individual should give informed consent for every study. “Nurses may feel conflicted if asked to help with research that’s not as well-defined, or an informed consent that’s not as clear as they think it ought to be,” says Turner.
• Ethical problems with research in the clinical setting.
“If nurses feel the patient is being treated more as a research participant than a patient, they are asked to step forward,” says Turner.
• Patient privacy involving media access to patient care areas.
“If there are newsworthy cases where the media is prowling about, nurses need to step forward and say, ‘You are not allowed here,’” says Turner.
• End-of-life issues, including physician-assisted suicide.
“Particularly in the states where physician-assisted suicide is becoming legalized, nurses are directed by the code not to participate,” says Turner.
The code won’t necessarily protect nurses from losing their jobs for stepping forward. “The code acknowledges that whistleblowing is not without inherent dangers,” says Turner. “But that does not absolve nurses of the responsibility to speak up.”
REFERNCE
- ANA Code of Ethics for Nurses with Interpretive Statements. 2015. American Nurses Association. Silver Spring, MD.
SOURCES
- Helen Stanton Chapple, PhD, RN, MA, MSN, CT, Nurse Ethicist/Associate Professor, Center for Health Policy and Ethics, Creighton University, Omaha, NE. Phone: (402) 280-2027. Fax: (402) 280-5735. Email: [email protected].
- Martha Turner, PhD, RN-BC, Assistant Director, Center for Ethics and Human Rights, American Nurses Association. Phone: (651) 967-1342. Email: [email protected].
